Respiratory and Sleep Medicine
Introduction:Department of Respiratory Medicine caters to the need of people having problems related to lungs,airways,pleura,mediastinum,diaphragm and chest wall.The specialty also covers those diseases that indirectly affect breathing like sleep apnoea and neuromuscular disorders.
The problems related to respiratory system are on the rise because of increasing air pollution,harmful effects of smoking and growing urbanization due to population pressure.Those who have symptomslike cough,phlegm,difficulty in breathing,chest congestion,blood in phlegm,disturbed sleep pattern due to snoring can approach the pulmonologist or respiratory specialist.Spectrum of diseases for which respiratory physician services are required are:
Department of Respiratory medicine provides consultative services in form of daily OPDs,as in-patients admitted in ICUs and wards and as interdisciplinary referrals.Department is well equipped with advanced diagnostic and therapeutic facilities needed for investigation and management of wide range of respiratory ailments.
Pulmonary Function Lab:
Pulmonary function tests help in assessment of functional status of lungs and give information about the likely cause of breathlessness.It measures how well a person can inhale or exhale air and how well the oxygen moves through lungs from atmosphere to body's circulation.
Our lab is well equipped with spirometry with diffusion and lung volume studies and these tests are performed by a trained technician in PFT lab .
1. Diagnose lung diseases such as asthma,COPD and ILD
2. Measure the progress of the disease and assess response to treatment
3. Assessment of lung function before surgery to predict the post operative complications
4. Measure the effect of occupational exposure(chemicals and gases) on lung functions
We have dedicated suit for endoscopy procedures.Our department is well equipped with bronchoscopes,semirigidthoracoscope and endobronchial ultrasound to look into and manage the problems related to airways,lung and pleura.
Bronchoscopy is a technique of examining the inside of airways for diagnostic and therapeutic purpose.The bronchoscope is inserted through nose or mouth after application of sprays and jelly in throat and nose.This isnon surgical,minimally invasive procedure done mostly on out patient basis.The procedure requires mostly topical anaesthesia or light sedation.This procedure allows doctor to identify abnormalities like foreign bodies,tumors,bleeding or inflammation of the airways.In the ICUs the procedure is done through endotracheal tube or tracheostomy and mainly required to remove secretions and clear airways.Bronchoalveolarlavage(BAL),Biopsy of lung,FNAC from mediastinallymphnodesare the sampling methods performed depending upon the indications.
Our bronchoscopy suite is equipped with all range of flexible and videobronchoscopes of both adult and pediatric size.
Semirgidendoscope meant for examination of pleura (space between outer and inner covering of the lungs) is thoracoscope.The procedure is also called pleuroscopy and is done in bronchoscopy suit under conscious sedation.
1. Foremost role of this procedure lies in identifying the cause of undiagnosed pleural effusion.
2. Loculated pleural collections which are difficult to drain can be easily cleared under vision
and help the entrapped lung to expand.
3. This procedure is also used to seal the pleural space when there isrepeated accumulation
of either air or fluid in the inthe pleural space causing difficulty in breathing.The
procedure is called pleurodesis.
The flexible bronchoscope equipped with an ultrasound probe at its tip is EBUS. This is the latest diagnostic tool in evaluating the masses and nodes out side the airways in the lung or mediastinum.The mediastinum is space between the lungs which was approachable only through surgery in the past.Advent of EBUS has made a paradigm shift in this filed. Being noninvasive , it helps avoid disabling diagnostic surgery and also cut shorts the expenditure and hospital stay. EBUS is performed either in topical anaesthesia,conscious sedation or short GA with laryngeal mask airway(LMA).Two modalities of EBUS are in place:
a)Linear EBUS for mediastinal lesions
b)Radial EBUS for peripheral lung masses.
• MediastinalLymphnodes:To differentiate tuberculosis, sarcoidosis or lymphoma
• Staging of lung cancer
• Diagnosis of primary lung tumors
• Mediastinal cyst
• To aid in certain therapeutic procedures
Polysomnography or sleep study is a test used to diagnose sleep disorders. Polysomnography records your brain waves,the oxygen level of your blood,heart rate and breathing as well as eye and leg movements during the study.The whole procedure has two parts
• Diagnostic study
• Titration study and both are usually done in the same night as 'split night study'.
1. Sleep apnoeaor other sleep related breathing disorder.In this condition there is habitual snoring,abnormal breathing pattern characterised by frequent pauses in airflow during sleep and daytime sleepiness.
2. Periodic leg movement disorder.In this disorder there is involuntary movement flexion and extension) of legs while sleeping.This is also called restless leg syndrome.
3. Narcolepsy.Overwhelming daytime drowsiness and sudden attacks of sleep are features of this condition.
4. REM sleep behaviour disorder.This disorder involves acting out dreams as you sleep.
5. Unusual behaviour during sleep.Your doctor may perform this test if you do unusual activities during sleep such as walking ,moving around a lot or rhtmic movements
6. Unexplained chronic insomnia.In case you consistently have trouble falling asleep or staying asleep your doctor may recommend polysomnography.
We have fully functional advanced sleep lab in our department to diagnose the above conditions.
Dr Sushil Upadhyay is senior consultant in respiratory medicine.He is post graduate(MD) in chest from GSVM Medical college Kanpur and European Diplomate in Adult Respiratory Medicine(EDRM). He has number of publications in national and international journals. He is working in the field of respiratory medicine and critical care since year 2000.